Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Guangzhou, China.
Cancer Med. 2023 Jul;12(14):15384-15403. doi: 10.1002/cam4.6112. Epub 2023 Jun 30.
Bladder cancer is the 13th most common cancer in China with the predominant histologic type being urothelial carcinoma (UC). Locally advanced and metastatic (la/m) UC accounts for 12% of UC and the five-year survival rate is only 39.4%, imposing a significant disease and economic burden on the patients. The aim of this scoping review is to synthesize existing evidence of epidemiology, the landscape of treatment options and associated efficacy and safety profiles, as well as treatment-related biomarkers among Chinese la/mUC patients.
A systematic search was conducted on five databases (PubMed, Web of Science, Embase, Wanfang, and CNKI) from January 2011 to March 2022 based on the scoping review criteria in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews.
A total of 6211 records were identified, and further review resulted in 41 relevant studies that met all criteria. Additional searches were conducted on epidemiology and treatment-related biomarkers of bladder cancer to supplement the evidence. Among 41 studies, 24 reported on platinum-based chemotherapy, eight on non-platinum-based chemotherapy, six on immunotherapy, two on targeted therapy, and one on surgery. Efficacy outcomes were summarized by line of therapy. Treatment-related biomarkers including PD-L1, HER2, and FGFR3 alterations were identified, and the alteration rate of FGFR3 of Chinese UC patients was lower than that of the western patients.
Despite chemotherapy has been the main treatment choice for decades, appealing new therapeutic strategies including ICIs, targeted therapies and ADCs were applied in clinical practice. Further research on epidemiology and treatment-related biomarkers of la/mUC patients is needed given only a limited number of studies have been identified thus far. High genomic heterogeneity and complexity of molecular features were observed among la/mUC patients; thus, further studies are required to identify critical drivers and promote potential precise therapies.
膀胱癌是中国第 13 大常见癌症，主要组织学类型为尿路上皮癌（UC）。局部晚期和转移性（la/m）UC 占 UC 的 12%，五年生存率仅为 39.4%，给患者带来了巨大的疾病和经济负担。本范围综述的目的是综合中国 la/mUC 患者的流行病学、治疗选择以及相关疗效和安全性概况以及与治疗相关的生物标志物的现有证据。
根据范围综述标准，按照系统评价和元分析扩展的首选报告项目指南，从 2011 年 1 月至 2022 年 3 月，在五个数据库（PubMed、Web of Science、Embase、万方和中国知网）上进行了系统搜索。
共确定了 6211 条记录，进一步审查后有 41 项符合所有标准的相关研究。还对膀胱癌的流行病学和治疗相关生物标志物进行了额外搜索，以补充证据。在 41 项研究中，24 项报告了基于铂的化疗，8 项报告了非基于铂的化疗，6 项报告了免疫治疗，2 项报告了靶向治疗，1 项报告了手术。按治疗线总结了疗效结果。确定了治疗相关的生物标志物，包括 PD-L1、HER2 和 FGFR3 改变，并且中国 UC 患者的 FGFR3 改变率低于西方患者。
尽管化疗已成为数十年的主要治疗选择，但包括 ICIs、靶向治疗和 ADC 在内的新的治疗策略已在临床实践中得到应用。鉴于迄今为止仅确定了有限数量的研究，因此需要对 la/mUC 患者的流行病学和治疗相关生物标志物进行进一步研究。la/mUC 患者中观察到基因组高度异质性和分子特征的复杂性；因此，需要进一步研究以确定关键驱动因素并促进潜在的精准治疗。
